If you’re injured at work, your capacity to undertake suitable employment is known as your ‘work capacity’.
work capacity assessments
Insurance agents are responsible for managing your claim and helping you to recover at work with appropriate support. As part of this process, they must assess your capacity to work. This is known as a ‘work capacity assessment’.
Workers with highest needs don’t need to undergo work capacity assessments, unless they ask for one and the insurance agent considers it appropriate.
Workers with highest needs are those with a level of permanent impairment of more than 30%. If you haven’t had your permanent impairment assessed yet and want to discuss whether you’ll meet this threshold, you should contact the insurance agent. You can also call us on 13 44 22 if you need help.
work capacity decisions
After conducting a work capacity assessment, the insurance agent will make a work capacity decision. This decision could affect your entitlements. It’s likely to be based on:
- your current work capacity
- what constitutes suitable employment for you and whether you can engage in that work without further injury the amount you’re able to earn in suitable employment
- the amount you’re currently earning
- the amount of your pre-injury average weekly earnings
- any other decision that affects weekly payments of compensation, including a decision to suspend, discontinue or reduce your weekly compensation payments.
review of work capacity decisions
Work capacity decisions can be reviewed a number of different ways.
Review by insurance agent
If you’re not happy with a work capacity decision, the first step is to ask the insurance agent to conduct an internal review. You should do this as soon as possible by completing the Work capacity – application for internal review by insurer form available on the SIRA work capacity disputes page. It’s important that you specifying the grounds on which you’re seeking the review and provide any new information.
Review by State Insurance Regulatory Authority
If you’re not satisfied with the outcome of the insurance agent’s internal review, or if the review isn’t completed within 30 days, you can ask SIRA for a Merit Review. You’ll need to complete the Work capacity – application for merit review by the authority form, available on the SIRA work capacity disputes page, and lodge it within 30 days of receiving the insurance agent's internal review decision.
For more information, please refer to the Guidelines for work capacity decision internal reviews by insurers and merit reviews by the authority available on the SIRA website.
Review by Workers Compensation Independent Review Office
If you’re still not satisfied, you can then lodge an Application for procedural review by the Workers Compensation Independent Review Officer (WIRO). You must do this within 30 days of receiving the merit review findings.
The WIRO will review the procedures followed by the insurance agent when making the work capacity decision. For more information, you can contact WIRO on 13 94 76.
The Workers Compensation Independent Review Office fact sheet contains general information about workers compensation entitlements and procedures.
We can also help you with understanding your entitlements – call us on 13 44 22.